Background: Effective literacy skills are crucial in supporting communication for children with severe speech and physical impairments (SSPI). Reading and spelling difficulties are reported to be over-represented in this group, even where language and cognitive skills are age appropriate. Aims: To compare the performance of children with SSPI on a range of language, reading and spelling tasks with that of their typically developing peers matched for receptive vocabulary and mental age. Methods & Procedures: A wide range of tasks was developed as part of a larger study exploring phonological awareness, reading and spelling skills. All tasks were accessible to children with severe physical impairments. Two groups of primary school-aged children were recruited, children with SSPI of average intelligence, and naturally speaking peers, matched for receptive vocabulary. Children were assessed individually on language, non-verbal cognition, phonological awareness, reading and spelling tasks. Outcomes & Results: Sixteen children with SSPI were recruited. Their performance was compared with that of 15 naturally speaking peers, matched for receptive vocabulary scores. The children with SSPI achieved significantly lower scores on reading and spelling measures relative to their naturally speaking peers. However, at least one participant with SSPI scored at ceiling on each task, indicating that SSPI do not preclude the development of reading and spelling, at least in the early stages of literacy development. Conclusions & Implications: This study indicates that some children with severe speech impairments can develop phonological awareness, reading and spelling skills. However, the data suggest that phonological awareness may not be as good a predictor of reading and spelling abilities in this group of children as in typically developing children. Further research is needed to track development of reading and spelling, as well as the instructional support needed to scaffold more effective skills in these areas. (Contains 5 tables.)